Alternative Health-Care Groups Push for `Choice' in Reform Bill A HURDLE FOR CONGRESS

WHEN President Clinton introduced his plan for health-care
reform, he stressed "freedom of choice" as a key goal. Many
Americans took that to mean they would still be able to choose
their own doctor or medical treatment.

But the word "choice" can have many meanings and apply to many
aspects of reform, from the question of abortion coverage to the
field of alternative medicine to the area of religious freedom.

As Congress struggles with the many issues of health-care reform
and appears headed toward a key vote in August, advocates aiming to
preserve freedom of choice are speaking out, hoping to influence
the legislation.

Most audible, and most threatening to the entire reform process,
are advocates on both sides of the abortion issue.

The legislation being considered includes abortion as a covered
benefit. But a strong anti-abortion faction in Congress, backed by
the National Conference of Catholic Bishops, threatens to sink
reform if abortion is covered.

Equally adamant are some members of Congress who insist on
keeping abortion as a basic benefit, but who do support a
"conscience clause" that allows individual doctors to choose not
to perform abortions.

In addition to the abortion debate there is a broader question:
How much choice in selecting treatment and providers will Americans
have under a federally mandated insurance program?

Already, a large number of Americans use alternative methods in
place of or in addition to conventional medicine.

A study published last year in the New England Journal of
Medicine found that in 1990, 34 percent of Americans used
alternative medical techniques, such as acupuncture, chiropractic,
homeopathy, and naturepathy, at a cost of $10.5 billion - a sum
equal to the money spent out-of-pocket by Americans for
hospitalizations. In most cases, these techniques were used along
with mainstream medicine. Increasingly, insurance companies are
covering some of the commonly used alternatives.
Who decides benefits?

Health-care reform throws open the question of what should be in
a basic benefits package - and focuses attention on the
government's role in deciding which methods should be encouraged.
Among the groups practicing alternatives, the most active lobbyists
are chiropractors.

The American Chiropractors Association (ACA) has a two-part
agenda: to ensure that a federal benefits package is defined to
cover chiropractors and to advance consumer choice.

"If the benefits package broadly defines `services of health
professionals' as those licensed by states, that would be fine with
us, provided there is committee report language naming
chiropractors by name," says Rick Miller, the ACA's chief
lobbyist. Every state licenses chiropractors.

To promote consumer choice, the ACA is pushing for a so-called
"any willing provider" provision. This would mandate that an
insurer cover treatment by a provider who fits this criterion. The
ACA also wants to prevent any bill from discriminating against
types of providers.

At issue is how broadly the government will define "health-care
professional." All the health-care bills provide for the creation
of a national commission that will set up a system to define
"medical necessity," but not to define the appropriate treatment.

Other alternative-medicine groups contacted said they were
monitoring the progress of legislation by keeping in touch with
members of Congress, such as Sen. Tom Harkin (D) of Iowa and Sen.
Barbara Mikulski (D) of Maryland, who are advocates for alternative
therapies.

Robert Duggan, director of the Traditional Acupuncture School in
Columbia, Md., says his aim is to make sure no procedures are
proscribed and that the question of who can provide treatment
remains a state issue. …

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